Suicidality and Non-Suicidal Self-Injury: A Narrative Review of Measurement, Risk, and Disparities among Minoritized and System-Involved Youth in the USA.

Suicidality and non-suicidal self-injury (NSSI) among youth in the United States continue to be a growing and serious public health concern. With alarming rates of suicide trending in the wrong direction, researchers are committed to bending the curve of suicide and reducing rates by 2025. Understanding the antecedents and conditions, existing measures, and disparate prevalence rates across minoritized groups is imperative for developing effective strategies for meeting this goal. This study presents a narrative review of the operationalization, measurement, risk factors (e.g., firearms and social media), and disparities across race, ethnicity, age, gender identity, ability, sexual orientation, immigration statuses, and system involvement (e.g., foster care and juvenile justice) of suicidality and non-suicidal self-harm across youth in the United States. Implications for research, practice, and policy approaches that incorporate positive youth development, cultural, and youth participation in interventions are discussed.

Examining the Utility of the Early Childhood Development Index (ECDI) among Children in the Nigeria Context.

An estimated 6 million children under the age of five in Nigeria (out of nearly 31 million) risk not reaching their full developmental potential. The dearth of context-relevant measures poses a challenge to the planning and implementation of effective interventions. This study assesses the utility of the Early Childhood Development Index (ECDI) in Nigeria. We used the Multiple Indicator Cluster Surveys to track progress among 3- to 4-year-old children (n = 11,073); 3-year-old, 51%; female, 49%. Using random calibration samples, the results from psychometric tests indicate that while over half of the children were on track in their development based on the ECDI, the instrument had low to average internal consistency and weak face validity, suggesting an inadequacy in capturing ECD information of value. At the outset of the launch of the new ECDI2030, the results of this study point to the need for continued discourse and advocacy for the use of culturally appropriate measures of child development, and a child-centered community engagement approach. This is essential in ensuring accountability and responsive interventions for the children served and their families.

Foster Care Involvement Among Youth With Intellectual and Developmental Disabilities.

Importance: Youth with intellectual and developmental disabilities (I/DD) are more likely to be placed in foster care than other youth. Examining the clinical and sociodemographic characteristics of youth with I/DD in the foster care system is critical for identifying disparities and understanding service needs. Objective: To produce a population-level analysis of youth with I/DD in foster care that examines differences in rates of foster care involvement based on race, ethnicity, age, and sex. Design, Setting, and Participants: This cross-sectional study involved all individuals with I/DD 21 years and younger enrolled in Medicaid through foster care in 2016 via data from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) for all 50 US states and Washington, DC. As a key insurer of I/DD services and foster care, Medicaid claims offer a timely population-level analysis. Youth with I/DD were grouped into diagnostic subgroups: autism spectrum disorder (ASD) only, intellectual disability only, or ASD and ID. The data analysis took place from July 2022 to September 2023. Exposure: TAF data contain Medicaid enrollment information by month with a binary indicator of foster care involvement, and eligibility files identify race, ethnicity, age, and sex. Main Outcomes and Measures: The period prevalence of foster care involvement was determined among I/DD youth by diagnostic subgroups using an intersectional approach across race, ethnicity, age, and sex. Logistic regression examined associations between risk for foster care involvement and race, ethnicity, age, and sex. Results: A total of 39 143 youth with I/DD had foster care involvement in 2016. Black youth (adjusted odds ratio [aOR], 1.37; 95% CI, 1.28-1.47) and females (aOR, 1.18; 95% CI, 1.1-1.27) had increased likelihood for foster care involvement. The likelihood for foster care involvement increased with age in all groups relative to the age group 0 to 5 years old. Conclusions and Relevance: This study found that among youth with I/DD, Black youth and females faced higher risk for foster care involvement, and the likelihood of foster care involvement increased with age. There is an urgent need for research that focuses on addressing system-level factors that drive increased risk. Understanding the specific health needs of Black and female youth with I/DD is critical to ensure the formation, implementation, and monitoring of equitable delivery of health services.

Stress Biomarkers in Black Youth: Exploring Psychological, Behavioral, and Socio-Ecological Correlates.

Exposure to chronic stress is a major public health concern. Black youth are vulnerable to chronic stress exposure given their overrepresentation in urban neighborhoods characterized by socio-ecological stressors. We contribute to this emerging body of knowledge by (1) investigating stress-induced variability in cortisol response patterns among Black youth, and (2) examining risk and protective factors associated with physiological stress responses. Salivary cortisol was collected from a community sample of 123 low-income Black youth ages 13 to 21. Latent class analysis (LCA) and logistic regression were utilized to identify discrete groups based on cortisol reactivity, and psychological, behavioral, and socio-ecological correlates of class membership. LCA supported a 2-class model of cortisol reactivity. Youth in class one were indicative of a normative stress response with mean cortisol awakening response of 0.38 µg/dL (SD = 0.19), 0.48 µg/dL (SD = 0.20) at time 2, and 0.44 µg/dL (SD = 0.20) at time 3. Youth in class two exhibited a blunted stress response with mean cortisol awakening response of 0.20 µg/dL (SD = 0.11), 0.21 µg/dL (SD = 0.09) at time 2, and 0.18 µg/dL (SD = 0.08) at time 3. Delinquent peer exposure and post-traumatic stress symptoms were negatively associated with blunted stress responses, while greater depressive symptoms were positively associated with blunted stress responses. Black youth displayed distinct physiological stress reactivity patterns. Interventions are needed to assist youth in coping with stress while transforming the upstream factors that give rise to adverse community conditions.

Structural and Intermediary Social Determinants of Health and the Emotional and Behavioral Health of US Children.

Children grow up in homes where varying environmental and socioeconomic contexts have a bearing on their emotional and behavioral health (EBH). This study used data from a representative sample of the child supplement of the US National Health Information Survey (NHIS) and applied the social determinants of health (SDoH) framework to explore factors associated with child EBH. We conducted a path analysis of the child's EBH measured by the strengths and difficulties questionnaire (SDQ) from their macro and socioeconomic contexts, e.g., policy, household, and other health system risk factors. For children in the sample, aged 4 to 17 years old (n = 9205), most path relationships to child SDQ scores were statistically significant. The total effects from a child's visit to a mental health specialist (0.28) and child's age (0.22) had the highest coefficients to child SDQ scores. A modified model showed a better fit with X2 (4) = 22.124, RMSEA = 0.021, and 90% CI [0.013-0.03], CFI = 0.98. Findings indicate that child factors such as being older, the use of mental healthcare services, and family socioeconomic status were significantly associated with EBH, calling attention to the need for more responsive policy and behavioral health interventions that address household/familial and child-level factors, critical determinants of child wellbeing.

Assessing the Modified Neighborhood Cohesion Index Among African American Adolescents Living in Public Housing: An Exploratory and Confirmatory Factor Analysis.

Objective: African American youth are disproportionately overrepresented in low-resourced segregated urban neighborhoods. Consequently, they experience greater exposure to neighborhood risks and subsequent depressive symptoms. Neighborhood cohesion represents a protective factor for youth in such environments. However, the concept remains underexplored among African American youth. This study examines the psychometric properties of a modified version of the Neighborhood Cohesion Index (NCI) among African American youth living in public housing. Method: Psychometric properties were assessed through exploratory and confirmatory factor analyses using data from African American youth (N = 235) living in public housing in two large northeastern cities. Results: The EFA resulted in the use of a single-factor structure with two dropped items and good internal validity. Findings from the CFA indicated that model fit indices were unacceptable for chi-square and RMSEA (χ2 [62; N = 235] = 170.19, p < .001); RMSEA = 0.09 [90% CI: 0.071, 0.102]) but were acceptable for SRMR and CFI (SRMR = 0.06; CFI = 0.91) with three error covariances. Conclusions: The modified NCI is not ideal for assessing neighborhood cohesion among this understudied population. Future research should prioritize psychometric testing alongside cognitive interviewing, to provide a contextualized measure of neighborhood cohesion for this population.

Feasibility, Acceptability and Preliminary Implementation of the Cornerstone Program for Transition-Age Youth with Mental Health Conditions: A Mixed Methods Study.

Transition-age youth with mental health conditions from low socio-economic backgrounds often drop out of mental health services and, as such, do not receive therapeutic doses of treatment. Cornerstone is an innovative team-based, multi-component intervention designed to address the clinical needs of this understudied population through coordination and extensive provision of services in vivo (in the community). The present study used a convergent parallel mixed-methods design. Researchers collected quantitative and qualitative data during a small developmental trial, analyzing the two data types independently and then exploring them side-by-side to evaluate feasibility, acceptability, and preliminary implementation. Semi-structured interviews and quantitative surveys were conducted with transition-age youth, clinic staff, and policy makers. Qualitative interview guides were developed using the Consolidated Framework for Implementation Research to build understanding on implementation determinants alongside feasibility and acceptability. A two-group preliminary randomized trial was conducted to assess feasibility outcomes, such as recruitment, randomization, measurement performance, and trends in pre- to post- outcomes. Using grounded theory coding techniques, transcripts were coded by multiple coders, and themes were identified on acceptability and implementation. The team recruited fifty-six transition-age youth. Randomization was used in the study and the intervention was provided without incident. Results suggest individual components with both the social worker and mentor were more acceptable to participants than group-based approaches. Thematic analyses revealed themes associated with the inner, outer, and policy contexts describing a range of critical implementation determinants. Findings suggest that Cornerstone is feasible, acceptable, and promising for transition-age youth. It represents an innovative multi-component intervention worth exploring for transition-age youth with mental health conditions in a larger efficacy trial.Trial registration: The trial was registered at ClinicalTrials.gov (NCT02696109) on 22 April 16, Protocol Record R34-MH102525-01A1, New York University, Cornerstone program for transition-age youth with serious mental illness: study protocol for a randomized controlled trial.

Feasibility of recruiting in prisons during a randomized controlled trial with people with serious mental illness.

BACKGROUND: Successful participant recruitment is vital to the feasibly of intervention research. In the behavioral and social sciences, intervention researchers face a myriad of recruitment barriers, many of which stem from working in real-world settings and among hard-to-access populations. Optimizing recruitment efforts requires being intentional about study planning and resource allocation, carefully documenting the outcomes of recruitment efforts, and developing and implementing procedures and strategies to overcome anticipated recruitment barriers. METHODS: The current article presents recruitment flowcharts to illustrate (a) the multistep recruitment process and (b) the points of potential participant attrition during recruitment from a two-phase group-based intervention study conducted among individuals with serious mental illness incarcerated in a state prison system in the U.S. In addition, qualitative methods are used to examine strategies employed during the study to support recruitment efforts. RESULTS: Despite challenges, this study was able to achieve recruitment goals. Analyses found the majority of potential participant attrition occurred prior to informed consent, highlighting the need for studies to track recruitment efforts in more detail than is currently recommended by commonly used guidelines. Strategies to optimize recruitment efforts included maximizing recruiter availability, developing a responsive communication approach, demonstrating respect for facility procedures and operations, and ensuring peak preparedness. CONCLUSION: Careful documentation of recruitment efforts and the early deployment of recruitment strategies is vital to the feasibility of intervention studies conducted in real-world settings with hard-to-access populations. The publication of recruitment procedures and outcomes can help future researchers anticipate recruitment challenges and inform recruitment goals, timelines, and strategies.

Exposure to community violence and depressive symptoms: Examining community, family, and peer effects among public housing youth.

Exposure to community violence is an epidemic problem that causes debilitating effects on youth mental health. However, the relationships between violence exposure and youth mental health remain unclear when examining co-occurring socioecological risk and protective factors. The purpose of this study is to clarify the observed gaps in knowledge by utilizing structural equation modeling (SEM) to examine the mediating role of community violence exposure on the relationship between perceived neighborhood risk factors, parental behaviors, and peers on depressive symptoms in a sample of urban youth in low-income public housing communities (n = 320). Results indicate that community violence exposure and exposure to delinquent peers mediates the effects of perceived neighborhood risk and parenting behaviors on depressive symptoms. These findings suggest that while interventions that limit exposure to community violence and delinquent peers could reduce depressive symptoms, interventions that reduce community violence are essential to improve youth mental health.

Aging out or continuing on? Exploring strategies to prepare marginalized youth for a transition to recovery in adulthood.

OBJECTIVE: This study aimed to improve our understanding of how to best assist marginalized youth during their transition to adulthood, and how to provide them services that help them achieve independence within existing public systems of care. METHOD: Using purposive sampling methods, 17 direct service providers and supervisors of a large behavioral health organization participated in individual interviews and focus groups. RESULTS: A team of analysts identified eight primary themes: (a) the primacy of consistent and caring relationships with adults; (b) working with youth and family concurrently; (c) the complicated dance of autonomy and independence; (d) engagement of alumni and peers in service delivery; (e) transition navigator: an active not passive approach to becoming an adult; (f) youth as the drivers of treatment and recovery; (g) provider training and resources to address the unique needs of transition-age youth; and (h) broadening the definition of treatment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our findings have important implications for practice, including (a) adapting clinical practice to meet the unique needs of transition-age youth and young adults; (b) engaging and expanding positive support systems; and (c) shifting the mindset of transition-age youth and young adults, their caregivers, and providers from a perspective of "aging out" of the mental health system to a perspective of "continuing on" in the management of their mental health through treatment and rehabilitation as needed as young adults. (PsycINFO Database Record (c) 2018 APA, all rights reserved).